Hospital risk management programs are regarded by many as one of the most promising responses to the medical malpractice problem. Such programs for the most part, however, have not been subjected to formal evaluation regarding their effectiveness in claim reduction or prevention. To a great extent, this is due to the recency of many programs, the amount of time required for malpractice claims to emerge and resolve (sometimes years after the clinical incident generating the claim), and the consequent length of time necessary to demonstrate a risk management program impact on the frequency of liability claims and payment amounts. The specific aims of this proposed project are: 1) To describe the clinical risk management (including peer review) programs and activities of Maryland hospitals during the decade of the 1980s, including time periods both before and after such activities were mandated by state law; 2) To examine relationships between clinical risk management activities and the malpractice claims experience of Maryland acute-care general hospitals (N=51) during the decade of the 1980s; 3) To assess the relative effectiveness of various risk management strategies and program elements in hospitals with differing levels of risk exposure; and 4) To explore alternative methods for estimating the short-term and long-term effects of risk management activities on medical malpractice claims and payments. The availability of information for Maryland hospitals on clinical risk management efforts (including peer review activities) beginning in 1980, as well as data on malpractice claims filed over a relatively long period (1978-the present), provides an opportunity to examine empirically some of these issues. This proposed project represents part of a collaborative effort among The John Hopkins School of Hygiene and Public Health, The Maryland Hospital Association and the Office of Licensing and Certification Programs, Maryland Department of Health and Mental Hygiene.